The purpose of this project was to develop and pilot test an interviewer-administered self-report questionnaire that might be used in a subsequent national survey to scientifically establish the prevalence of second-party elder abuse or neglect. Acknowledging that elder abuse and neglect can occur in institutional as well as residential settings, the project focused only on those living in the communities who were capable of accurately self-reporting their knowledge, attitudes, and practices.
Accordingly, this project was funded to develop innovative self-report methods for estimating the annual incidence and prevalence of elder abuse and mistreatment (including physical
abuse, psychological abuse, neglect by a second party, and exploitation) in the community.
Based on the results of the focus groups and the field trips with the Adult Protective Service (APS) workers, a structured questionnaire amenable for computer assisted in-person or telephone interviewing was developed. The questionnaire was developed for computer-assisted interviewer administration either in person or over the telephone in either English or Spanish. Preliminary testing of the instrument was conducted with community-dwelling cognitively intact elder volunteers in the Tampa area. Aging services case managers screened and recruited 95 clients aged 65 and older, with 25 clients who had reports of mistreatment within the hotline database, and 70 comparison clients (no reports of mistreatment). Groups were matched by gender and age within 10 years. The interviews were conducted over an 18-month period, of which 3 interviews were conducted in-person and 92 interviews were conducted by telephone. All interviews were conducted by trained interviewers of the research team. Twenty-six interviews were conducted in Spanish.
A volunteer/convenience sample was utilized.
In order to obtain the sample of abuse target cases, the Area Agencies on Aging (AAAs) and the local service delivery organizations identified initial lists of 530 cases of second party abuse or neglect. Of these cases, they tried but were not able to contact 83 (including 4 decedents and 1 no longer receiving services), another 352 had no record of any attempted contacts, and the remaining 95 were contacted by the agencies and considered as active cases. Of these 95 active cases, 13 (14 percent) were not able to self-report according to the agencies, 26 (27 percent) refused to give permission to be contacted, and 56 (59 percent) agreed to be contacted by the interviewers.
In order to obtain the sample of nonabuse comparison cases, initial lists of 1,103 potential matched control clients (i.e., clients receiving services but not identified as abused elders) were selected by the agencies. Of these 1,103, 2 were deceased, 2 were not able to self-report according to the agencies, 23 were no longer clients, 2 refused to give permission to be contacted, 40 were unable to be contacted, 922 had no record of any attempted contacts, and the remaining 112 were considered by the agencies as active nonabuse cases and gave permission to be contacted.
All known victims of second party elder abuse receiving home and community based services in the seven sites in Florida in 2007 and 2008.
Trained interviewers administered the questionnaire in person or by telephone.
computer-assisted personal interview (CAPI)
In addition to the cognitive screen that
was administered in the first minutes of the interview, a variety of demographic questions were asked along with an assessment of respondents' independence/dependence in basic activities of
daily living and instrumental activities of daily living. The questionnaire also asked a series of
screening items designed to ascertain whether the respondent experienced any one of 19 specific types of elder abuse or neglect during the previous year.
Section 1 was titled internally "Cognitive Screen" (questions 1-7). This section began with two
general items about self-assessed health and self-assessed memory. The respondents were then administered a modified version of the Mini Mental State Examination (MMSE) to verify their capacity to provide consent and establish their ability to give a reliable self-report.
For those respondents who passed the cognitive screen, the questionnaire continued with Section 2, internally titled "Living Arrangements and Children" (questions 8-210). In
this section, demographic information was sought, including current marital status, prior marital history, household composition, and a listing of all the living children (up to ten) and step-children (up to nine) the respondent has, the frequency of their visits in person and on the telephone, and the respondent's perception of trust of each of these
Section 3, internally titled "ADL/IADL" [Activities of Daily Living/Instrumental Activities of Daily Living] (questions 211-288) assessed the respondent's function in 6 basic ADLs including walking across a small room, bathing, dressing, eating, transferring from a bed to a chair,
and toileting; and 12 ADLs including using the telephone, grocery shopping, food preparation, routine light housekeeping, occasional heavy housekeeping, laundry, managing prescription medications, taking care of finances, taking care of one's social life, making medical appointments and seeing
medical personnel, personal shopping, and traveling within the community.
In Section 4, internally labeled "SES" [Socioeconomic Status](questions 289-307), the questionnaire
proceeded to elicit information about power of attorney, home ownership, and 15 sources of income or services.
Section 5, internally labeled "Mistreatment" (questions
309-362) asked the respondent if he or she had ever experienced any one of 17 specific forms of abuse, and 2 items that the APS staff indicated were often correlated with elder abuse -- whether they were afraid of anyone inside or outside their home, and whether the police had come to their home.
Of the 56 cases of second party abuse identified by the AAAs who gave permission to be contacted by the interviewers, 5 (9 percent) were deceased by the time of contact, 15 (27 percent) failed the cognitive screen, 7 (12 percent) were not able to be contacted, 3 (5 percent) refused consent to be interviewed, and 26 (46 percent) were interviewed, for a response rate among the cases of 72 percent (26/56 -- 5 decedents + 15 who failed the cognitive screen).
Of the 112 cases of AAA clients who were not known to be victims of second party abuse who gave permission to be contacted by interviewers, 7 (6 percent) were deceased by the time of contact, 24 (21 percent) failed the cognitive screen, 2 (2 percent) were not were able to be contacted, 10 (9 percent) refused consent to be interviewed, and 69 (62 percent) were interviewed, for a response rate among the controls of 85 percent (69/112 -- 7 decedents + 24 who failed the cognitive screen).
The total response rate among cases and controls was therefore 81 percent (95/168 -- 12 decedents + 39 who failed cognitive screen).
A subset of the Mini Mental Status Examination (MMSE) was used in the questionnaire. The 5 items included: (1) registration (i.e., repeat 3 words), (2) attention (i.e., serial subtraction of 7's from 100), (3)
short-term memory (i.e., recalling 3 words immediately after they were offered), (4) delayed memory (i.e., recalling those same 3's words after an interval of approximately 2 minutes of answering other items in the questionnaire), and (5) orientation to time (i.e., giving the correct month, day, year, and day of the week).